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The Soloist: A Preamble

Why high stakes are attached to schizophrenia in film

The recently and ubiquitiously released The Soloist tells the true story of an unlikely friendship between a journalist, Steve Lopez, and a homeless, schizophrenic musician, Nathaniel Ayers. Soon, millions of people will have watched this cinematic, pseudo case study and for many this experience will constitute the core of what they know about the disorder.

Public perception is an important thing, especially when it comes to mental illness. Most people leave this issue to culturally shaped assumptions, which infers the worst - that the mentally ill are weird, if not downright scary. Most disorders are, in fact, mild to extreme versions of ‘normalcy.' A patient with social anxiety disorder (SAD - cute, huh), for instance, gets just a little more stressed, sensitive and tightly wound over hosting a party then the average person (whatever that means). It's hard to pick someone with SAD out of a lineup. Schizophrenics are different. They stand out.

Combine the fact that all psychiatrically diagnosed individuals are stigmatized to some degree with the fact that the strangest subgroup, schizophrenics, wears their disorder visibly on their sleeve and you've got the makings of a serious public relations problem.

And since it is statistically improbable and socially unusual for a schizophrenic to be your neighbor or friend, respectively, the image of the schizophrenic is predominately constructed through movies, television shows and books. Cinematic history, in particular, has been a relatively cruel and unfair advocate (think the drooling, mumbling citizens of the backward in One Flew over a Cuckoo's Nest, or the alienated and frightful killer in Spider). The end result is an image of a creepy predator. If the average person, for example, enters a restaurant and spots a schizophrenic, conventional wisdom might guide his/her subconscious to say, "Hmmm, there's at least a decent chance this guy might do something odd like snort eggs through his nose and, hmmm, he might even try something scary like grabbing little Johnny..."

Although recent films have taken a turn for the more positive and realistic (think the soft-spoken genius in A Beautiful Mind), the bad rap continues. This is unfortunate for many reasons not the least of which is that the schizophrenic life is difficult enough (intermittent hospitalizations, difficulties with long-term social and occupational attachments and medications that are far from fun) without public perception adding to a schizophrenic's burden. And we should care. One percent of the general population has schizophrenia and that's, well, a lot of people. Further, a tenth of the general population has certain core personality traits (a.k.a schizotypal personality disorder) that are susceptible to schizophrenia given enough stress.

Consequently, when major motion pictures that spotlight schizophrenics enter theaters separating fact from fiction becomes a civic duty. Coming soon will be a review that reality tests The Soloist.

There is much still unknown about schizophrenia, but there is also a lot that is known.
A fair and realistic portrayal involves two steps: debunking popular myths and flushing out the realistic personality features and idiosyncrasies. Outlined below are some initial thoughts.

Step 1:

Fiction #1: Schizophrenics are dangerous. Fact: Schizophrenics are rarely as violent as people think. Moreover, alcoholics and the uninhibited crowd, namely anti-social personality disordered individuals, exhibit a far higher degree of violent behavior.

Fiction #2: Schizophrenia afflicts people mysteriously, without warning or understanding. Fact: Tentatively, the cause is believed to be an interaction of genes and prenatal stress, meaning, a schizophrenic mother who catches the flu in the second trimester. Add the stress of negative life events and you have the best known explanation.

Step Two:

Schizophrenic-specific quirk #1. There are five types of schizophrenia, three of which have been around for centuries - catatonic, paranoid, disorganized and two of which have been added in the past few decades for no apparent reason other than to make doctors feel smarter and more secure - the residual type (when you used to have the disorder but now appear perfectly fine) and the undifferentiated type (when you have all of the above). Other psychological variables dictate the type one exhibits - for instance, if you have high intelligence then you'll be paranoid.

Schizophrenic-specific quirk #2: They perform worse across the board cognitively. The tools of intelligence - the ability to focus, remember, process, articulate and analyze - are disrupted or compromised. This is not ADHD, a drug-induced haze or mental retardation. Being schizophrenic, according to one professor in clinical psychology, is like walking around with someone screaming in your ear.

Stay tuned to learn if The Soloist serves to help or hurt the people it seeks to portray.